Resistencia a ciprofloxacina en infecciones urinarias por Escherichia coli

ARTÍCULO PUBLICADO EN REVISTA EXTERNA. Introducción: La infecciones urinarias tienen una elevada incidencia y habitualmente son leves, por lo que en la mayoría de los casos, la prescripción de un tratamiento se realiza de forma empírica antes de disponer de los resultados microbiológicos. Al elegir un tratamiento empírico es importante considerar que su resistencia bacteriana se encuentre por debajo de un 20%. Objetivo: Evaluar la prevalencia de resistencia antibiótica de Escherichia coli uropatógena a ciprofloxacina y sus variables relacionadas. Material y métodos: Se realizó un estudio descriptivo, retrospectivo y transversal, sobre una muestra de 363 urocultivos de pacientes adultos, donde se analizó el microrganismo infectante y su resistencia antibiótica. Resultados: En los pacientes estudiados el principal patógeno fue E. coli, con una prevalencia por encima del 70%. La prevalencia de resistencia a ciprofloxacina fue de 22,18%. Se encontró una prevalencia de resistencia a ampicilina/sulbactam (AMS) del 38,12% y se evidenció relación significativa de la misma en pacientes de la unidad de cuidados intensivos. Discusión: El uso de antimicrobianos de amplio espectro, la flora microbiana intrahospitalaria, la internación prolongada, la instrumentación y la falta de conciencia del personal de salud en cuanto a medidas de higiene y seguridad otorgan un terreno óptimo para el desarrollo de resistencias indeseables. Sitio de la revista: https://saludpublica.ugr.es/investigacion/revista-electronica/contenido/202

Factores influyentes en el retorno al trabajo en pacientes quemados : una revisión narrativa

Tesis (Kinesiólogo)Las quemaduras son un importante y creciente motivo de consulta y hospitalización lo que asociado a una elevada morbimortalidad hace necesario un manejo multidisciplinario continuo del paciente quemado, desde el momento de la lesión, durante la recuperación y la rehabilitación. Este manejo es un desafío para el equipo de salud en su conjunto, debido a que las quemaduras tienen diferentes patrones de presentación, gravedad, variedad de tratamientos, lo prolongado y tórpido de su evolución, así como también su elevado costo económico y social. Dentro de los cuidados que necesita el paciente quemado también es fundamental, además de las atenciones físicas, aquél que va dirigido especialmente al área emocional. Aun cuando se le entreguen todos los tratamientos relacionados directamente con la lesión, sin recibir una atención psicológica especializada será muy difícil lograr una reinserción familiar, social y laboral exitosa. Con respecto a lo anterior, la búsqueda de la atención al paciente se entiende como un planteamiento más integral, a diferencia de lo que se presenta en la Guía Clínica MINSAL 2016, la cual se centra en el tratamiento médico otorgado en centros hospitalarios, donde se mantiene el modelo biomédico de atención

Piezometric and ground deformation relationship at Almonte-Marismas aquifer (Andalucía, Spain)

[EN] Groundwater is one of the most important hydric resources of the Spain territory. Nevertheless, heavy groundwater withdrawal generates severe consequences, being land subsidence one of them. The Interferometric Synthetic Aperture Radar (InSAR) technique have been recently exploited to detect and monitor aquifer related deformations. In the present work, relationship between piezometric levels drawdowns and land subsidence has been studied for the higher withdrawals areas within Almonte-Marismas aquifer system (which holds the Doñana Natural Space). Four datasets of radar satellite images, obtained from Sentine-1 satellite, have been processed using the InSAR technique in the period 2014 - 2020. Results show that in some of these areas, like those surrounding El Rocío and Matalascañas villages, the correlation between these two variables is high.[ES] El agua subterránea es uno de los recursos hídricos más importantes en el territorio español. La gran cantidad de agua que se retira de ellos puede tener graves consecuencias, entre las que destaca, en algunos acuíferos, la subsidencia del terreno. La técnica de interferometría radar (InSAR), ha sido desarrollada en las últimas décadas para detectar y monitorear las deformaciones relacionadas con los acuíferos. En este trabajo se estudia la posible relación existente entre la variación de los niveles piezométricos y el movimiento del terreno en zonas con grandes extracciones del acuífero Almonte-Marismas (sobre el que se ubica el Espacio Natural de Doñana). Para ello, se han analizado los datos de deformación del terreno obtenidos del satélite Sentinel-1 en el periodo 2014-2020 Los resultados muestran que, en alguna de estas zonas, como las cercanas a las poblaciones de El Rocío y Matalascañas, la correlación entre ambas variables es alta.Este trabajo es parte de las actividades subvencionadas dentro del Sistema Nacional de Garantía Juvenil (PEJ2018-002477), financiado por la Fundación Tripartita para la Formación en el Empleo, la iniciativa YEI (Youth Employment Initiative) y el Fondo Social Europeo (FSE). Los datos Copernicus Sentinel-1 se obtuvieron y procesaron en la plataforma GEP de la ESA en el marco del GEP Early Adopters Programme. Agradecemos al IGME y a la CHG por proporcionar los datos de piezometría, así como a la Junta de Andalucía por suministrar los datos meteorológicos.González-Jiménez, M.; Guardiola-Albert, C.; Aguilera-Alonso, H.; Béjar- Pizarro, M.; Herrera, G.; Ezquerro, P.; López-Vinielles, J.... (2021). Estudio de la relación entre la piezometría y la deformación del terreno en el acuífero Almonte-Marismas (Andalucía, España). En Proceedings 3rd Congress in Geomatics Engineering. Editorial Universitat Politècnica de València. 102-108. https://doi.org/10.4995/CiGeo2021.2021.12675OCS10210

Los niños en Argentina : propuesta de monitoreo del sistema normativo y las políticas públicas a la luz de los derechos humanos

Frente a un tratado internacional de derechos humanos, cada Estado tiene libertad de adherir o no. Si así lo hiciere, asume compromisos que refieren al respeto, protección y garantía del efectivo ejercicio de los derechos allí estipulados. Así, el Estado debe realizar esfuerzos, que refieren a la adecuación de la normativa y el diseño e implementación de políticas y programas para cumplir con tales compromisos. El Estado se compromete además a presentar informes periódicos que den cuenta de los avances y esfuerzos realizados. Las Naciones Unidas sostienen que un punto crucial para evaluar el grado de cumplimiento de los países, es la carencia de información específica por parte de los Estados, tanto en lo que respecta a la normativa, políticas y programas, cuanto al avance en el ejercicio de los derechos. Dicho organismo reconoce además la dificultad de los países para generar instrumentos de control, o indicadores que permitan hacer un seguimiento, por lo que ha respondido, al igual que otros organismos, con diferentes propuestas, pero que no han sido llevadas a la práctica. En este marco, el presente proyecto tiene como finalidad desarrollar las bases generales de un sistema continuo de indicadores de derechos que, tomando como guía los principios del Enfoque de Derechos Humanos, permita el seguimiento y evaluación de los compromisos asumidos por Argentina, en este caso en particular, ante la Convención sobre los Derechos del Niño (CDN)Fil: Santillán Pizarro, María Marta. Universidad Católica de Córdoba. Facultad de Ciencia Política y Relaciones Internacionales; ArgentinaFil: Harrington, María Inés. Universidad Católica de Córdoba. Facultad de Ciencia Política y Relaciones Internacionales; Argentin

Variation in Colonoscopy Performance Measures According to Procedure Indication

BACKGROUND & AIMS: Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. METHODS: We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. RESULTS: Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49–0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55–0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22–0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71–2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20–1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30–11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32–2.14). CONCLUSIONS: Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication

Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study

Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P =. 001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P =. 693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P =. 001), lower time from booster (P =. 043) and past breakthrough SARS-CoV-2 infection (P <. 001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infectionThe present project has been supported by Fresenius Medical Care, Diaverum, Vifor Pharma, Vircell, Fundación Renal Iñigo Álvarez de Toledo and ISCIII FEDER funds RICORS2040 (RD21/0005

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort

Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p&lt;0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions: In our global cohort, death was the outcome in &gt;10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO